Previously in this blog we have examined a number of cases involving medical malpractice claims. One common thread in these cases is the involvement of the state’s medical review panel. This is because claims brought against healthcare providers under the Louisiana Medical Malpractice Act must be reviewed by a medical review panel before proceeding to court. The panel is made up of three doctors and one attorney. The panel’s purpose is limited: its authorized by statute only to determine whether the evidence supports the plaintiff’s allegation that the defendant healthcare provider failed to observe appropriate standard of care in the plaintiff’s treatment and, if the standard was not met, whether the failure contributed to the plaintiff’s injury. The panel is specifically prohibited from rendering conclusions about issues of material fact that do not require on an expert opinion. The panel’s report, which it issues in writing, is considered an expert opinion which, though not conclusive, is admissible in any subsequent legal action.
In this post, the first of two on the case of McGlothlin v. Christus St. Patrick Hospital, we will explore the Third Circuit’s treatment of the trial court’s erroneous admission of the medical review panel’s faulty opinion. The facts are as follows: In 1999, after nearly a decade of suffering with osteoarthritis, Margie McGlothlin checked into Christus St. Patrick Hospital in Lake Charles for a double total knee replacement. The surgery was successful, and McGlothlin’s initial recovery uneventful. Three days after the procedure, McGlothlin was transferred from the main hospital to the rehabilitation wing. While there, McGlothlin alleged that she fell and injured her left knee on two separate occasions when the nursing assistants who were attempting to transfer her did so without assistance. McGlothlin, claiming that these falls caused the dislocation of her knee cap, first submitted her claim for damages to a medical review panel as required by the Louisiana Medical Malpractice Act. The panel rejected McGlothlin’s claim, and she filed suit. During the trial, the parties did not dispute that McGlothlin sustained a kneecap dislocation while under the care of the hospital and that the standard of care for moving a double knee replacement patient requires the assistance of more than one trained attendant. But the hospital denied that either of the two falling events alleged by McGlothlin occurred at all and instead suggested that her dislocated kneecap resulted from physical therapy (a risk with all knee replacement procedures). Following a three-day trial, the jury returned a verdict for Christus St. Patrick’s, and McGlothlin appealed.
One enumeration of error offered by McGlothlin centered on the trial court’s admission of an edited version of the medical review panel’s report. The editing resulted from McGlothlin’s objecting during the trial to the hospital’s attempt to introduce the report into evidence. McGlothlin argued that the report contained non-expert conclusions of issues of material fact, which violated the limited authority granted to the panel by state law. Specifically, the panel determined that there was “no violation of the applicable standard of care without even stating what that standard of care was. Instead, the panel’s written reasons addressed only the factual conflicts raised by the information” presented by the parties. In an effort to preserve as much of the panel’s report as possible, the trial court redacted from the report the panel’s conclusion as well as part of the last sentence, which stated “but we feel that the versions of both of the incidents by the patient and her family appear to have numerous inconsistencies.” The Third Circuit stated, “a clear reading of what remains of the medical review panel’s opinion establishes to the reader that the underlying dispute was factual and not legal.” Furthermore, one of the hospital’s trial witnesses was an orthopedic surgeon who served as a member of the medical review panel. Although the trial court ruled that the witness could not, during testimony, state what the panel’s (redacted) conclusion was, the witness “made it clear in his testimony that his opinion and that of the panel were based on factual findings.” Thus, despite the trial court’s attempt to shield the report’s impermissible conclusions from the jury, its members were “fully informed” about how the panel’s opinion was reached and that it had concluded the hospital did not violate the standard of care. The court held that the trial court’s improper admission of the medical review panel’s redacted opinion and the surgeon’s direct testimony about the inner workings of the panel “tainted the integrity of the trial.” Accordingly, the court determined that a de novo review of the record was required.
In a subsequent post, we will look at the court’s analysis of McGlothlin’s enumeration of error that there was no “reasonable factual basis” for the jury’s conclusion that the hospital was free of liability.